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Mycoses. 2020 Feb 3. doi: 10.1111/myc.13056. [Epub ahead of print]

Invasive Pulmonary Aspergillosis treatment duration in haematology patients in Europe: an EFISG, IDWP-EBMT, EORTC-IDG, SEIFEM survey.

Author information

1
Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
2
Institut Pasteur, CNRS, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR2000, Paris, France.
3
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
4
University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
5
Policlinico Universitario Agostino Gemelli - IRCCS.
6
Università Cattolica del Sacro Cuore, Roma.
7
SEIFEM (Sorveglianza Epidemiologica Infezioni nelle EMopatie).
8
Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
9
Division of infectious diseases University of Genoa (DISSAL), Ospedale Polyclinico San Martino, Genova, Italy.
10
Université de Lorraine, APEMAC, équipe MICS, and Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France.
11
Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven Belgium, department of Haematology, University Hospitals Leuven, Leuven, Belgium.
12
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain.
13
Department of Infectious Diseases, Hospital Clinic, IDIBAPS (Institut d'Investigacions Biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain.
14
Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
15
Unit for Mycology, Statens Serum Institut, Copenhagen, Denmark.
16
Dept Clin Medicine, University of Copenhagen, Copenhagen, Denmark.
17
Dept Clin Microbiol, Rigshospitalet, Copenhagen, Denmark.
18
Reference Unit for Parasitic and Fungal Infections, Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge. Lisbon, Portugal.
19
Department of Microbiology, Oslo University Hospital, Oslo, Norway.
20
North-Western State Medical University, Department of Clinical Mycology, Allergy and Immunology, Saint Petersburg, Russian Federation.
21
Hacettepe University Medical School, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
22
National Reference Laboratory for Medical Mycology, University of Belgrade , Belgrade, Serbia.
23
Clinic for Infectious and Tropic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
24
National and Kapodistrian University of Athens, Greece.
25
Department of Laboratory Medicin, Karolinska University Hospital, Stockholm.
26
Oncology and Hematology, University Hospital of Strasbourg, Université de Strasbourg, UMR-S1113 / IRFAC, Inserm, Strasbourg, France.
27
Department of Hematology, Radboud University Medical Centre, Nijmegen, Netherlands.
28
University of Cologne, Faculty of Medicine, Department I of Internal Medicine, University Hospital of Cologne, Germany.
29
Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria.

Abstract

BACKGROUND:

Invasive pulmonary aspergillosis (IPA) optimal duration of antifungal treatment is not known.

OBJECTIVES:

In a joint effort, four international scientific societies/groups performed a survey to capture current practices in European hematology centers regarding management of IPA.

METHODS:

We conducted in 2017 a cross-sectional internet-based questionnaire survey to assess practices in sixteen European countries concerning IPA management in hematology patients including tools to evaluate treatment response, duration and discontinuation. The four groups/societies European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG), Infectious Diseases Working Party-European Society for Blood and Bone Marrow Transplantation (IDWP-EBMT), European Organisation for Research and Treatment-Infectious Disease group (EORTC-IDG) and Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) were involved in the project.

RESULTS:

112 physicians from 14/16 countries answered the survey. Galactomannan antigen was available in serum and bronchoalveolar lavage in most centers (106/112 (95%) and 97/112 (87%) respectively), quantitative Aspergillus spp. PCR in 27/112 (24%) centres, β-D-glucan in 24/112 (21%) and positron emission tomography in 50/112 (45%). Treatment duration differed between haematological malignancies, with a median duration of 6 weeks [IQR 3-12] for patients with AML, 11 [4-12] for patients with allogenic stem cell transplantation and GvHD and 6 [3-12] for patients with lymphoproliferative disease. Treatment duration significantly differed according to country.

CONCLUSION:

Essential IPA biomarkers are not available in all European countries and treatment duration is highly variable according to country. It will be important to provide guidelines to help with IPA treatment cessation with algorithms according to biomarkers availability.

KEYWORDS:

Aspergillosis; Aspergillus PCR; European country; PET CT; biomarker; galactomannan antigen; survey; treatment duration

PMID:
32009262
DOI:
10.1111/myc.13056

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